Provider Demographics
NPI:1306228135
Name:CUSIMANO, ASHLEY J (APRN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:CUSIMANO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:JAKOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 MEDICAL CENTER BLVD
Mailing Address - Street 2:ER
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3147
Mailing Address - Country:US
Mailing Address - Phone:504-349-1533
Mailing Address - Fax:504-349-1530
Practice Address - Street 1:2215 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6322
Practice Address - Country:US
Practice Address - Phone:504-838-3524
Practice Address - Fax:504-828-6155
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP08394OtherLICENSE
MS02084269Medicaid
LA2396536Medicaid